Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality worldwide, accounting for 31% of all deaths globally. Canada is no exception, with CVDs being the second leading cause of death, accounting for approximately 30% of all deaths in the country (1). Despite this high prevalence, the implementation of cardiac rehabilitation (CR) programs in Canada is suboptimal. This article aims to explore the state of CR in Canada, identify its shortcomings, and suggest solutions to improve its implementation.
Cardiac Rehabilitation in Canada
Cardiac rehabilitation (CR) is a comprehensive program designed to improve the health outcomes of patients with cardiovascular diseases. It includes exercise training, education, lifestyle modification, and psychological support. CR has been shown to reduce mortality, morbidity, hospitalizations, and improve the quality of life in patients with CVDs (2).
Despite the benefits of CR, its implementation in Canada is suboptimal. The Canadian Cardiovascular Society (CCS) recommends that all patients with CVDs should be referred to CR programs, yet only a fraction of patients actually receive it (3). The CCS also recommends that CR programs should be offered in hospitals and community settings, but the availability of these programs varies across the country.
Barriers to Implementation
Several barriers contribute to the suboptimal implementation of CR in Canada. These include:
Lack of referral: Many patients are not referred to CR programs by their healthcare providers. Studies have shown that only 40-60% of eligible patients are referred to CR programs (4). This is due to a lack of knowledge about the benefits of CR, inadequate resources, and insufficient time.
Limited access: Even when patients are referred to CR programs, access to these programs is limited. Many programs are only available in urban areas, making it difficult for patients in rural areas to participate. Additionally, there is a shortage of CR programs, and long waitlists are common.
Cost: Although CR is cost-effective in the long run, the initial cost can be a barrier to implementation. Patients may be required to pay out-of-pocket for the program, and many cannot afford it.
Lack of diversity: CR programs in Canada do not always reflect the diverse population of the country. Studies have shown that CR programs are often designed with a middle-aged, male population in mind (5). This can lead to a lack of cultural sensitivity and exclusion of certain groups.
Solutions to Improve Implementation
To improve the implementation of CR in Canada, several solutions can be implemented. These include:
Education: Healthcare providers need to be educated on the benefits of CR and the guidelines for referral. This can be done through continuing education programs and the dissemination of evidence-based guidelines.
Increased funding: The government should provide increased funding for CR programs to improve access and reduce the cost for patients. This can be done through public-private partnerships and collaborations between hospitals and community organizations.
Expansion of programs: CR programs should be expanded to rural areas to improve access for patients in these areas. Additionally, programs should be designed with cultural sensitivity in mind to ensure that all patients feel welcome and included.
Tele-rehabilitation: Tele-rehabilitation has been shown to be an effective alternative to traditional CR programs, particularly for patients in rural areas (6). This can improve access and reduce the cost of the program.
Conclusion
Cardiac rehabilitation is a vital component of the management of patients with cardiovascular diseases. Despite the benefits of CR, its implementation in Canada is suboptimal. Barriers to implementation include a lack of referrals, limited access, cost, and a lack of diversity. Solutions to improve implementation include education, increased funding, expansion of programs, and telerehabilitation. By addressing these barriers. Dr. A. Arrazaghi. MD,FRCPC